Oregon Ranks at the Bottom in Oral Health

Dr. Bruce Austin, 10 months into his job as Oregon’s first state dental director, says poor oral health is Oregon’s “hidden epidemic,” leading to worse overall health especially in children; he advocates statewide fluoridation among other solutions.

According to a 2012 Oregon Smile Survey taken at 82 schools statewide, 17,000 Oregon kids between ages six and nine – about 13 percent — have seven cavities or more with rampant decay including rows of black bumps for teeth. Three percent of that age group – some 3,800 Oregon children — are in pain needing urgent care.

Dental issues are the most common health problem for Oregon children, Austin said — four times more common than asthma in teens. Dental infections can lead to blood or even brain infections.

Yet in 2013, Oregon ranked last out of 50 states for getting kids at least one preventive dental visit during the year.

Children rely on emergency rooms when pain becomes unbearable, a “costly option and dental problems aren’t solved in the emergency room,” Austin said. At best, ERs can give antibiotics and painkillers without addressing the cause of the pain.

A metric for dental sealants was incorporated into the Coordinated Care Organizations earlier this year. But that school-based program, while effective at reducing decay, costs an average of $40 per child with costs rising to $138 per child when dental teams must travel long distances to schools.

The Oregon Community Foundation has a $3 million, five-year initiative with other funders to provide grants to nonprofits to put dental coordinators in 15 counties. Counties, schools, CCOs, dental providers and others coordinate to give care and kits. “A lot of these kids don’t even have their own toothbrushes,” said Melissa Freeman, director of strategic projects.

Freeman is the first to acknowledge the initiative’s limitations. No coordinators serve the far southeastern Oregon counties where the 2012 Smile Survey showed 73 percent of first- through third-graders had a cavity compared with about half the kids in that age group in the rest of the state. The program received no applications from Harney, Malheur or Baker counties although her foundation is talking to the Eastern Oregon CCO to remedy that in later funding rounds.

Oregon Health Authority Director Lynne Saxton countered that she’s “excited to be entering new territory” with an independent philanthropic organization that sees a problem and tries to solve it. Saxton also applauded the foundation for supporting water fluoridation to fight dental disease in the failed 2014 Portland fluoridation ballot measure campaign.

Oregon ranks 48th out of 50 states in optimally fluoridated public water systems. For every $1 spent on water fluoridation, an average of $38 is saved on dental treatment costs per person per year, Austin said.

Oregon’s State Health Improvement Plan calls for nearly 80 percent of Oregon’s communities to have optimally fluoridated water, which will require Oregon to join 15 states with statewide fluoridation laws.

“[Community water fluoridation] is the most cost-effective and equitable way to reduce decay across the population and lifespan regardless of geography, income, race and ethnicity,” Austin said.